Provider Demographics
NPI:1699096743
Name:BALANCE CHIROPRACTIC INC
Entity type:Organization
Organization Name:BALANCE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-332-6201
Mailing Address - Street 1:835 HIGHWAY 105
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-9069
Mailing Address - Country:US
Mailing Address - Phone:719-332-6201
Mailing Address - Fax:
Practice Address - Street 1:835 HIGHWAY 105
Practice Address - Street 2:SUITE A
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-9069
Practice Address - Country:US
Practice Address - Phone:719-332-6201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty